10- 144 C.M.R. ch. 272, § VI-IX
Current through 2024-51, December 18, 2024
Prior authorized services are available through the C.C.S./C.S.H.N. Program for pediatric malignancies and their complications as follows:
For those children who are referred by their primary care provider, the Maine Children's Cancer Program or other approved pediatric cancer treatment program for subspecialty diagnostic and treatment services, the C.C.S./C.S.H.N. Program will pre-authorize payment for:
diagnostic evaluation by a pediatric hematologist or oncologist. This evaluation may include laboratory tests, x-rays and other imaging studies and related hospitalization costs; surgical components of the plan of care to include related hospitalization costs upon receipt of the report of the evaluation; office visits and hematology/oncology inpatient and outpatient services during active cancer treatment or complications of treatment including as outlined in the child's plan of care; chemotherapy and radiation therapy; medication prescribed by the treating subspecialist including prescription pain medication; prostheses and orthoses; rehabilitative services to include physical, occupational and speech/language therapy for up to six (6) months following surgery or if required as a result of the complications of chemotherapy; community-based nursing services as requested in the hematologist's/oncologist's plan of care; medical nutrition therapy with a registered dietitian; routine and restorative dental care up to $150.00/year at state rates of reimbursement during active cancer treatment; and/or office visits with the pediatric hematologist or oncologist and related tests for up to three (3) years following the completion of the child's treatment.NON-COVERED SERVICE: bone marrow transplants.
10- 144 C.M.R. ch. 272, § VI-IX